<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html lang="en" xml:lang="en" xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset="iso-8859-1" />
<html>
<head>
<title>Sample form from WorxWare.com</title>
<style>
body, p, table, th, td, div {
  font-family: Arial, Helvetica, sans-serif;
  font-size: 12px;
}
th {
  background-color:#0080C0;
  color:white;
  font-weight:bold;
  font-size:18px;
  border: 1px solid #0080C0;
}
input.text, textarea {
  font-family: Arial, Helvetica, sans-serif;
  font-size: 11px;
  width: 99%;
}
.text:focus, textarea:focus {
  background-color: #FFFACC;
  border: 1px solid #000000;
}
#mydiv {
  margin-left: auto ;
  margin-right: auto ;
  width: 500px;
  text-align: left;
}
td.colone {
  text-align: right;
  vertical-align: top;
  padding-top:6px;
  width:20%;
}
td.coltwo {
  color:red;
  text-align: center;
  vertical-align: top;
  padding-top:9px;
}
td.colthree {
  width:80%
}
table.border {
  border: 1px solid #0080C0;
  border-collapse: collapse;
}
</style>
</head>
<body>
<div id="mydiv">
<form method="POST" action="../_lib/phpmailer-fe.php" enctype="multipart/form-data">
<input type="hidden" value="samplecontactus.html" name="referer">
<table class="border" width="500" cellpadding="3" cellspacing="0">
  <tr>
    <th colspan="3" align="center">WorxWare.com Sample Contact Us Form</th>
  </tr>
  <tr>
    <td colspan="3"><div style="height:5px;"></div></td>
  </tr>
  <tr>
    <td class="colone">Name</td>
    <td class="coltwo">*</td>
    <td class="colthree"><input class="text" type="text" name="frmName" style="width:98%;"></td>
  </tr>
  <tr>
    <td class="colone">City</td>
    <td class="coltwo">&nbsp;</td>
    <td class="colthree"><input class="text" type="text" name="frmCity" style="width:98%;"></td>
  </tr>

  <tr>
    <td class="colone">CityArr</td>
    <td class="coltwo">&nbsp;</td>
    <td class="colthree"><input class="text" type="text" name="frmCityArr[]" style="width:98%;"></td>
  </tr>
  <tr>
    <td class="colone">CityArr</td>
    <td class="coltwo">&nbsp;</td>
    <td class="colthree"><input class="text" type="text" name="frmCityArr[]" style="width:98%;"></td>
  </tr>


  <tr>
    <td class="colone">Email</td>
    <td class="coltwo">*</td>
    <td class="colthree"><input class="text" type="text" name="email" style="width:98%;"></td>
  </tr>
  <tr>
    <td class="colone">Telephone</td>
    <td class="coltwo">&nbsp;</td>
    <td class="colthree">
      <table width="100%" cellpadding="0" cellspacing="0">
        <tr>
          <td width="200"><input class="text" type="text" name="frmTelephone" style="width:200px;"></td>
          <td>
            <select size="1" name="frmPhoneType">
            <option value="Home">Home</option>
            <option value="Worx">Worx</option>
            <option value="Pager">Pager</option>
            </select>
          </td>
        </tr>
      </table>
    </td>
  </tr>
  <tr>
    <td class="colone">Contact by</td>
    <td class="coltwo">&nbsp;</td>
    <td class="colthree">
      <table width="100%" cellpadding="0" cellspacing="0">
        <tr>
          <td width="1">
            <select size="1" name="frmContactBy">
            <option value="Telephone">Telephone</option>
            <option value="Email">Email</option>
            </select>
          </td>
          <td>
            <select size="1" name="frmBestTime">
            <option value="Morning">in Morning</option>
            <option value="Afternoon">in Afternoon</option>
            <option value="Evening">in Evening</option>
            </select>
          </td>
        </tr>
      </table>
    </td>
  </tr>
  <tr>
    <td class="colone">Message</td>
    <td class="coltwo">*</td>
    <td class="colthree"><textarea class="text" name="frmMessage" style="width:98%;height:100px;"></textarea></td>
  </tr>
  <tr>
    <td class="colone" colspan="2">&nbsp;</td>
    <td class="colthree"><input type="submit" value="Submit" name="submit"><input type="reset" value="Reset" name="reset"></td>
  </tr>
  <tr>
    <td colspan="3"><div style="height:5px;"></div></td>
  </tr>
</table>
</form>
<span style="color:red;">*</span> = required<br />
</div>
</body>
</html>
